Question 1
A PSW is caring for a client with advanced chronic obstructive pulmonary disease (COPD) who has a documented care plan indicating a low-flow oxygen prescription. During personal care, the PSW notices the client's lips and fingertips appear bluish, the client is using accessory neck and shoulder muscles to breathe, and they can only speak two to three words between breaths. What is the most appropriate PSW action?
- A. Increase the oxygen flow rate on the concentrator to relieve the client's distress, then continue with personal care.
- B. Reassure the client that this breathing pattern is normal for COPD and proceed slowly with the care routine.
- C. Stop personal care immediately, ensure the client is in an upright position, call for emergency assistance, and stay with the client until help arrives. ✓ Answer
- D. Offer the client a glass of cold water, encourage slow deep breaths, and monitor for ten minutes before deciding whether to call the supervisor.
Explanation: Cyanosis (bluish discolouration of lips and fingertips), use of accessory muscles, and the ability to speak only two to three words between breaths are signs of severe respiratory distress requiring immediate emergency intervention. A PSW must never independently adjust prescribed oxygen flow rates, as doing so is outside PSW scope of practice and can be dangerous in COPD clients who rely on a hypoxic drive. The correct action is to stop all activity, position the client upright to maximize lung expansion, activate emergency services, and remain with the client to provide reassurance and monitor until help arrives.
Question 2
An older adult client with type 2 diabetes reports numbness and tingling in both feet and tells the PSW that they sometimes cannot feel when their feet touch the floor. The PSW should recognize this as which condition and respond how?
- A. Diabetic peripheral neuropathy; inspect the client's feet carefully at each visit, ensure safe footwear is worn, and report any skin changes or injuries to the supervisor. ✓ Answer
- B. Normal aging of the nervous system; reassure the client that decreased sensation in the feet is expected and no special measures are needed.
- C. Peripheral vascular disease; apply a warm foot soak daily to improve circulation and sensation.
- D. Deep vein thrombosis; elevate the feet above heart level and massage the calves to restore blood flow.
Explanation: Numbness, tingling, and reduced sensation in the feet in a client with diabetes is consistent with diabetic peripheral neuropathy, caused by chronic high blood glucose damaging peripheral nerves. Because the client cannot feel pain or pressure, injuries can go unnoticed and lead to serious complications including ulcers and infection. The PSW role includes systematic foot inspection at each visit, ensuring properly fitting footwear is worn at all times, and reporting any new skin breakdown, blisters, or wounds to the supervisor promptly. Warm soaks are contraindicated in diabetes due to burn risk, and massage over possible thrombosis sites is contraindicated.
Question 3
A PSW is assisting an older adult client who has rheumatoid arthritis and notices the client's finger joints appear red, warm, and swollen compared to yesterday. The client rates their pain as 7 out of 10. Which action is most appropriate for the PSW?
- A. Apply a warm compress to the joints and gently perform passive range-of-motion exercises to reduce stiffness.
- B. Encourage the client to push through the pain during morning care and complete all exercises as scheduled.
- C. Withhold all personal care activities for the shift and document that the client refused.
- D. Avoid manipulating the affected joints during care, document the observations, and report the signs of a possible flare to the supervisor. ✓ Answer
Explanation: Redness, warmth, and swelling in a client with rheumatoid arthritis indicate an acute inflammatory flare. During a flare, the PSW must not apply heat or perform exercises on acutely inflamed joints, as this can worsen joint damage. The correct PSW action is to provide gentle personal care avoiding the inflamed joints, document objective observations, and report to the supervisor so the care plan can be adjusted by the appropriate regulated health professional.
Question 4
During an outbreak of influenza in a long-term care home, the facility implements a no-visitation policy and cohorts ill residents. A PSW who is assigned to the outbreak unit asks whether they may also be assigned to the non-outbreak unit the same day to cover a staffing shortage. What is the most appropriate response based on IPAC outbreak principles?
- A. The PSW may float between units as long as they perform hand hygiene and change their uniform between assignments
- B. The PSW should not be assigned to both units during an active outbreak, as this risks transmitting the pathogen from the outbreak unit to the non-outbreak unit ✓ Answer
- C. The PSW may float if they wear a surgical mask throughout their entire shift on both units
- D. Floating between units is only restricted for PSWs who are showing symptoms of influenza themselves
Explanation: During a declared outbreak, Ontario IPAC and Public Health Ontario guidelines recommend cohorting staff to outbreak units to prevent transmission of the outbreak pathogen to unaffected areas. Even asymptomatic staff can carry and shed influenza virus. Hand hygiene and masking alone do not eliminate the risk of transmission via clothing or indirect contact when moving between outbreak and non-outbreak units. The facility's outbreak management plan should restrict staff movement, and the PSW should communicate the staffing concern to their supervisor rather than floating independently.
Question 5
A PSW is caring for a client in a long-term care home and needs to empty a urinary catheter drainage bag. After donning gloves, the PSW empties the bag into a measuring container and notes the output. What is the correct next step before documenting and moving to the next task?
- A. Remove gloves, document the output, then perform hand hygiene
- B. Remove gloves and immediately perform hand hygiene before touching any shared surfaces or documentation tools ✓ Answer
- C. Keep gloves on while documenting to avoid contaminating the chart with bare hands
- D. Rinse gloves under running water and proceed to the next client
Explanation: After handling body fluids such as urine, the PSW must remove gloves and immediately perform hand hygiene (Moment 3 — after body fluid exposure risk) before touching any shared surfaces, documentation tools, or other equipment. Wearing gloves while documenting transfers pathogens to shared items. Rinsing gloves is not an acceptable substitute for changing them, as gloves can develop micro-tears and rinsing does not render them safe for subsequent tasks.
Question 6
A PSW in a retirement home is assisting with meal preparation in the common kitchen and notices that a co-worker wiped the counter with a cloth used earlier to clean up raw chicken juice, then used the same cloth to wipe a cutting board for vegetables. What is the primary infection prevention concern with this practice?
- A. The cloth may spread chemical cleaning product residue onto the vegetables
- B. The cloth can transfer bacteria such as Salmonella or Campylobacter from raw poultry to ready-to-eat food surfaces, causing cross-contamination ✓ Answer
- C. Reusing the cloth will reduce its absorbency and make cleaning less effective
- D. Raw chicken juice contains viruses that can survive on cutting boards for up to 72 hours
Explanation: Cross-contamination occurs when pathogens from a contaminated source (raw poultry, which commonly carries Salmonella and Campylobacter) are transferred to a ready-to-eat food surface via a contaminated cloth or utensil. This is a key food safety and IPAC principle relevant to PSW practice in residential and community settings. The PSW should report this practice and, within scope, use separate cloths or single-use paper towels and ensure surfaces are cleaned and disinfected between tasks.